2017 Renewal of Individual and Family Medical Plans

Insurance companies are mailing renewal information for individual and family policies, both benefit and premium changes. Some of the benefit changes are positive, some are not but most of these changes are dictated by The Affordable Care Act (ACA) commonly referred to as Obamacare. In most cases the premium increases are very substantial. I do not have complete rates for all the insurance companies as of yet.

Changes for 2017 cannot be made until November 1st for an effective date of January 1, 2017.

The individual health insurance market is shrinking. I will be setting phone appointments to begin on November to review plans. I strongly encourage that you to contact me. If you want to set a phone appointment with me, please respond to this e mail now and I will send you dates and times as options beginning in November.

Before your phone appointment, I will need to know the exact spelling of the names of doctors you want to continue to see, including their zip code. I will also need the exact spelling of any medications you need and the dosage.

If you believe you may be eligible for a subsidy through Covered California, I need to know your Estimated Modified Adjusted Gross Income for 2017. If you do not report a 2017 amount, I cannot complete a Covered California application as it will not be accepted into their system. I would encourage you to have a discussion with your tax professional. I need this information at the time of a phone appointment.

Some Grandfathered plans will be discontinued in 2017, we need to discuss replacement of those plans.

Blue Shield of California Individual and Family Plan 2017 Renewal

Blue Shield of California will be mailing your renewal information, both benefit and premium changes. Some of the benefit changes are positive, some are not but most of these changes are dictated by The Affordable Care Act (ACA) commonly referred to as Obamacare. In most cases the premium increases are very substantial. I do not have complete rates for all the insurance companies as of yet but I am told the rate increases will be much the same.

Here is what needs to be done:

Changes for 2017 cannot be made until November 1st for an effective date of January 1, 2017. You have to wait until November 1st.

The individual health insurance market is shrinking. I will be setting phone appointments to begin on November 1st to review your plan. I strongly encourage you to contact me. If you want to set a  phone appointment with me, please respond to this e mail and I will send you dates and times as options.

Before your phone appointment, I will need to know the exact spelling of the names of doctors you want to continue to see, including their zip code. I will also need the exact spelling of any medications you need and the dosage.

If you believe you may be eligible for a subsidy through Covered California, I need to know your Estimated Modified Adjusted Gross Income for 2017. The 2016 guide is attached for reference. The 2017 figures should be very close. If you do not report a 2017 amount, I cannot complete a Covered California application as it will not be accepted into their system. I would encourage you to have a discussion with your tax professional. I need this information at the time of a phone appointment.

Some Grandfathered plans will be discontinued in 2017, we need to discuss replacement of those plans.

 

Medicare and Social Security Trustees Warn of Shortfalls

Below is an article discussing the financial state of Medicare and Social Security. There is a pending rate increase in Medicare premiums.

Medicare and Social Security Trustees Warn of Shortfalls

By ROBERT PEARJUNE 22, 2016 New York Times

Carolyn W. Colvin, the acting commissioner of Social Security, during a news conference in Washington on Wednesday. Credit Andrew Harnik/Associated Press

WASHINGTON — The Obama administration said Wednesday that the financial outlook for Medicare’s hospital insurance trust fund had deteriorated slightly in the last year and that Social Security still faced serious long-term financial problems.

The report, from the trustees of the two programs, could inject a note of fiscal reality into a presidential campaign that has given scant attention to the government’s fiscal challenges as the population ages. Hillary Clinton, the presumptive Democratic presidential nominee, has proposed increasing Social Security benefits and allowing people age 55 to 64 to “buy into” Medicare, while Donald J. Trump, the presumptive Republican nominee, has repeatedly said he would not cut either program.

Under existing law, the trustees said Wednesday, Medicare’s hospital trust fund would be depleted in 2028, two years earlier than projected in last year’s report.

In addition, they said, the Social Security trust funds for old-age benefits and disability insurance, taken together, could be depleted in 2034, the same year projected in last year’s report. Tax collections would then be sufficient to pay about three-fourths of promised benefits through 2090, they said.

Social Security and Medicare account for about 40 percent of all federal spending.

Obama administration officials often say the Affordable Care Act has slowed the growth of health spending, compared with estimates made just before the law was adopted in 2010.

But the trustees said Wednesday that the short-term financial outlook for Medicare had worsened in the last year because of changes in their assumptions and expectations. Medicare actuaries now expect higher use of inpatient hospital services, as well as lower projected improvements in workers’ productivity and lower payroll tax revenue, as a result of slower growth in wages in the next few years.

In their report, the trustees — four administration officials — said that the costs of Medicare and Social Security would grow faster than the economy through the mid-2030s because of the aging of the baby boom generation. As for Medicare, they said, “growth in expenditures per beneficiary exceeds growth in per capita gross domestic product over this time period.”

The projected growth in Medicare spending will not immediately set off automatic cuts in the program under a controversial provision of the Affordable Care Act that generally requires such cuts when spending is expected to exceed certain benchmarks. However, such cuts could be required in a few years under the trustees’ forecast.

President Obama told an audience in Elkhart, Ind., this month that Social Security should paid for “by asking the wealthiest Americans to contribute a little bit more.” Credit Zach Gibson/The New York Times

Under current projections, they said, the automatic cuts could take effect for the first time in 2019.

Medicare now spends an average of nearly $13,000 per beneficiary, and this figure is expected to exceed $16,000 in five years, the report said.

“High-cost drugs are a major driver of Medicare spending growth,” said Andrew M. Slavitt, the acting administrator of the federal Centers for Medicare and Medicaid Services.

Such projections in years past have prompted leaders in both parties to at least broach the idea of benefit cuts or tax increases for entitlement programs.

By contrast, President Obama said in Elkhart, Ind., this month that Social Security should be made “more generous,” and that “we could start paying for it by asking the wealthiest Americans to contribute a little bit more.”

Treasury Secretary Jacob J. Lew said Wednesday that he saw no contradiction there. The two objectives — ensuring the solvency of Social Security and increasing benefits — are “not at all inconsistent” if they are discussed in the context of “a broader conversation” about taxes and benefits, he said.

The report predicts that Social Security will provide a modest cost-of-living adjustment, increasing benefits by two-tenths of 1 percent next year. But, it warned of a “substantial increase” in Medicare premiums in 2017 for about 30 percent of beneficiaries. Under assumptions in the report, the standard premium, now $121.80 a month, would rise to $149, and the change could be announced just weeks before Election Day on Nov. 8.

Congress took action last year to shore up Social Security’s disability insurance trust fund, but the report says the legislation was a short-term fix. The law postponed the projected depletion of the disability trust fund by seven years, to 2023, Mr. Lew said.

Like other Democrats, Mr. Lew said the report showed the “positive impact” of the Affordable Care Act. Since the health law was signed, he said, “increases in health care costs have slowed substantially.”

Carolyn W. Colvin, the acting commissioner of Social Security, said Americans should begin a serious discussion of how to close the “future financing gap” in Social Security. Sixty million people now receive Social Security benefits totaling more than $74 billion each month. The number of Social Security beneficiaries is expected to reach 76 million by 2025.

Drugs: Paying for firms’ gifts to doctors

This article appears in the Business Briefing of the Los Angeles Times dated June 21, 2016.

It discusses the harm caused to the patient when a physician accepts gifts from drug companies. This practice has been around for many years, hopefully with more scrutiny it will end.

DRUGS

Paying for firms’ gifts to doctors

As little as one free meal from a drug company can influence which drugs doctors prescribe for Medicare patients, according to a study using Medicare records and recently released data from the Affordable Care Act’s Open Payments program.

The study highlights subtle ways doctors may feel inclined to prescribe a drug after receiving just a small gift, even if the drug is more costly for patients and their insurance plans.

Researchers calculated that an estimated $73 billion a year could be saved if equivalent generics were prescribed instead of brand-name drugs, and patients pay for a third of that excess cost. The study was published Monday in the journal JAMA Internal Medicine.

Costs top healthcare concerns

This article from the Los Angeles Times, dated June 11, 2016 indicates that the cost of healthcare is a primary concern for our country. It also indicates that there is much confusion regarding Obamacare.

In my opinion the cost of healthcare will decrease significantly when physicians understand nutrition, exercise and psychological well being and will be able to effectively communicate this to patients. Everyone must be responsible for incorporating this in their lives.

USC DORNSIFE/LOS ANGELES TIMES POLL
Costs top healthcare concerns
A poll finds state residents more worried about rising prices than access.
BY DAVID LAUTER
WASHINGTON — Six years after President Obama signed the Affordable Care Act, the health reform law has gained acceptance from a majority of California voters, but the cost of getting healthcare remains a major concern, eclipsing worries about having insurance, according to a new USC Dornsife/Los Angeles Times poll.

The widespread worry about costs indicates a potential shift in the debate over healthcare, at least in this heavily Democratic state.

Nationally, the political debate has been stuck for most of the last six years on Republican efforts to block Obamacare, but that gridlock could lessen after the election.

In both parties, lawmakers increasingly have been hearing complaints from their constituents about the cost of care, and polls have found that prescription drug prices, surprise medical bills and other pocketbook issues concern voters more than the future of the health law.

Echoing that national trend, almost two-thirds of voters in the USC/Times survey say they worry “very much” about rising health costs, with only 10% saying that is not something they worry about.

Just slightly more than half say that lack of insurance is something they worry about a lot, and roughly three in 10 say they were not worried about it.

Latinos, however, were an exception, reporting equal levels of unease about cost and having insurance — three-quarters said they were very worried about each.

Cost concerns were most widespread among those in their 50s and early 60s. Indeed, that age group consistently showed the highest levels of anxiety on a series of healthcare concerns.

By contrast, those over age 65, most of whom are covered by Medicare, were the least likely to express worry about healthcare issues.

For a significant number of voters, the healthcare law itself takes blame for rising costs. Just over half of those surveyed said they believed that costs for average Americans have “gone up a lot” because of the law, compared with roughly one-third who said that the law had not caused that to happen.

As with many aspects of the healthcare debate, partisanship plays a big role in shaping beliefs about rising costs: Republicans by overwhelming margins blame the law, while Democrats were split closely on whether it’s responsible.

Most Americans have been forced to confront increased costs for health coverage for years — a trend that began long before the passage of the reform law.

Employers have continued to shift costs to their workers, mostly in the form of higher deductibles and co-payments. Although those higher costs may not have been caused by the new law, many blame it.

The law clearly has raised costs for one relatively small slice of Americans — mostly healthy, self-employed people with middle-class or higher incomes who were previously able to buy low-cost policies on the private market.

The new law requires those people to buy more comprehensive policies, which provide greater coverage, but at a higher price. Covering sicker customers who used to be denied insurance has also led insurers to raise some premiums.

Low- and middle-income Americans get subsidies under the law that lower their monthly premiums, but higher-income Americans do not.

More than three-quarters of California voters acknowledge the biggest effect the law has had — reducing the number of Americans who lack health coverage. By 77% to 15%, voters said that the law had achieved that goal.

Since the new law’s coverage expansion began in 2014, some 20 million previously uninsured Americans have gained coverage, and the share of American adults under age 65 who are uninsured has dropped from one in five to about one in eight, according to numerous private and government surveys.

But on that point, too, partisanship colors perceptions. Among Republicans, 28% in the current survey said that the new law had not led to more people having insurance. Among Republicans who identify with the tea party, 48% took that view, compared with 31% who said the law had reduced the number of uninsured.

The public’s view remains split on another of the law’s major accomplishments, as well — ending the ability of insurers to deny health coverage because of preexisting health conditions. The poll found 59% of voters saying that coverage could no longer be denied, while 21% said that had not happened.

On that question, the division did not appear primarily partisan. Instead, some of the groups whom the new law was designed to help most appeared least aware of one of its central elements.

Latinos, those younger than 30 and people with incomes under $30,000 were all less aware of the change regarding preexisting health conditions than whites and those who were older or more affluent. Among Latinos, for example, though 48% said the law had accomplished that goal, 30% said it had not.

That lack of awareness of one of the law’s main achievements marks a “messaging failure” by the law’s supporters, said Anna Greenberg, the Democratic pollster whose firm forms half of the bipartisan team that produced the survey for USC and The Times.

The White House and its allies have struggled at times to convey a message about the law, in part because for many Americans, it remains an abstraction.

Just over half of those surveyed said the law had no effect on themselves or their families. That’s by design: The law was written to cover the uninsured while minimizing the effect on people who get coverage through their jobs, as most working-age Americans do.

That has cost Obama politically. The views that most Americans have of the law have been shaped less by direct experience than by partisanship, according to Drew Altman, the president of the Kaiser Family Foundation, which has carefully tracked opinion about the health law.

Only about four in 10 of those who supported the law in the poll also said it had made their own families’ healthcare better.

Overall, 53% of the state’s voters favor the law, with 31% favoring it strongly. An additional 12% said they opposed it because it did not go far enough, while 27% said they opposed it because it went too far.

Those who said the law did not go far enough do not consistently back liberal views on how to replace it.

Only 40%, for example, supported a single-payer system — the sort of healthcare solution advocated by Sen. Bernie Sanders in his campaign for president.

By contrast, those who support the law backed the single-payer idea 69% to10%. Overall, just over half of the state’s voters supported it, with about one-quarter opposed.

The state’s voters divided evenly on the question of whether to repeal the law’s requirement that people have insurance.

Opinion on that question split along predictable partisan lines with one significant exception — Latinos, who generally back the law, also supported repeal of the mandate, by 57%-37%.

Most California voters have a positive view of their own healthcare and a somewhat positive view of healthcare in the state, the poll found. Seven in 10 rated their own healthcare as “excellent” or “good” while just under three in 10 called their care “fair” or “poor.”

Ratings were highest among those earning more than $100,000 a year and among those aged 65 and older, which reflects the generally positive view that Americans have of Medicare.

Asked about the state of healthcare in California, 44% called it excellent or good, while 34% said fair and 14% poor.

Ratings were gloomier about healthcare nationwide, with only 30% calling it either excellent or good, 39% fair and 25% poor.

The poll for the USC Dornsife College of Letters, Arts and Sciences and the Los Angeles Times was conducted jointly by the Democratic firm Greenberg Quinlan Rosner Research and the Republican firm American Viewpoint. It questioned 1,500 registered California voters from May 19-31. The margin of sampling error is 2.9 points in either direction for the full sample. david.lauter

@ latimes.com  .
DAVID BUTOW For The Times

 

Firm Accused of Bilking Medicare

From the Los Angeles Times Business Section, dated May 26, 2016

Firm bilked Medicare, U.S. says
Justice Department joins whistle-blower case accusing Prime Healthcare of overbilling.
BY PAUL SISSON
The U.S. Justice Department has joined a whistle-blower case against Prime Healthcare Services, adding significant weight to allegations of widespread Medicare overbilling at 14 of the company’s hospitals in California.

A Los Angeles magistrate judge granted the agency’s request to intervene in the case Tuesday, one day after the government declared in a court filing that its investigation of the Ontario- hospital operator has “yielded sufficient evidence” that the facilities “submitted or caused the submission of claims to Medicare for unnecessary inpatient stays.”

Prime finds itself under federal scrutiny because of a whistle-blower complaint submitted in 2011 by Karin Berntsen, a registered nurse and director of quality and risk management at Alvarado Hospital in San Diego. Berntsen’s lawsuit accuses Prime of routinely making Medicare patients’ illnesses seem more severe than they really were in order to justify billing for additional services and increasing hospital admissions.

Berntsen alleged that this practice occurred not only at Alvarado but also at 13 other Prime properties. Most of these hospitals are in Southern California, including Centinela Hospital Medical Center in Inglewood, Encino Hospital Medical Center, Sherman Oaks Hospital and Huntington Beach Hospital.

Berntsen’s litigation estimates the total amount of overbilling at $50 million, an amount that now could result in a significant financial payoff for her — and potentially large damages against the company.

Anti-fraud statutes allow fines of $5,500 to $11,000 — plus triple damages under certain circumstances — for each false or inaccurate bill submitted by hospitals and other healthcare companies . Whistle-blowers are entitled to 15% to 25% of the money recovered in cases involving the Justice Department.

In 2012, for example, pharmaceutical giant GlaxoSmithKline agreed to pay $2 billion to the federal government to resolve accusations that it overbilled for the prescription drugs Paxil, Wellbutrin and Avandia. In 2006, Tenet Healthcare was crippled after paying $900 million in a case involving alleged Medicare bill-padding, kickbacks and changing of billing codes to obtain higher reimbursements.    Prime has denied Berntsen’s allegations, calling them “speculative nonsense” after her complaint was unsealed in 2013.

In a new statement issued after the federal government’s intervention, the company was a bit more subdued. It said Medicare billing is complex and that there is a “lack of clarity between what federal regulators and physicians believe is necessary to adequately document medical necessity for hospital admissions.”

Prime also said its hospitals have successfully undergone Medicare billing audits conducted by an array of organizations, including the Joint Commission, the Healthcare Facilities Accreditation Program, the California Department of Public Health and government “recovery audit” contractors who are rewarded for spotting billing irregularities. The company currently owns 43 hospitals across14 states.

“Over 600 medical records that were appealed to the Administrative Law Judges and Medicare Appeals Council, all had rulings in Prime Healthcare’s favor, with no exception,” Prime’s statement said. “Given this precedence of successful appeals on thousands of claims, Prime Healthcare is confident it will prevail and ultimately be exonerated.”

But the Justice Department in a wide-ranging investigation referenced in its court filing this week cited “multiple witnesses who have worked at different Prime hospitals” who told the government that Dr. Prem Reddy, Prime’s chairman, president and chief executive, criticized emergency department physicians and demanded “their termination if he decided they were passing up opportunities to cause the admission of Medicare beneficiaries.”

The agency said those witnesses also accused Reddy of requesting “increased work schedules for [emergency department] doctors whose patients had a relatively high rate of admission,” of decreasing or discontinuing such shifts for physicians with low rates and of telling emergency department doctors “to find a way to admit all patients over 65 because they all have insurance.”

In contrast, the government said, Reddy allegedly worked to minimize hospital stays for uninsured patients — instructing that they should stay in the emergency department for only six to eight hours to get test results and then be discharged.

The Justice Department also cited the results of a Medicare contractor’s review of the company’s hospital admissions that “put Prime on notice of the same pattern of seemingly unnecessary inpatient admissions.”

Kathleen Clark, a Washington attorney who is an expert on the False Claims Act that governs whistle-blower cases, said the government’s involvement raises the stakes, given that federal regulators participate in only about one-quarter of such cases.

“It is actually quite significant when the government decides to intervene in one of these cases. The government brings to bear significant investigatory resources and leverage,” Clark said. “Intervention is seen not as a guarantee of a win, but it’s a very good sign for the whistle-blower and [his or her] lawyers.”

Marlan Wilbanks, an Atlanta attorney who is one of several lawyers representing Berntsen, said the government’s involvement could turn up additional evidence in the case disproving Prime’s assertion that previous audits proved the company’s billing practices are sound.

“Those entities were not designated to look for fraud,” he said. “Prime was given the benefit of the doubt. However, those entities did not have the evidence and the documents that the government and [Berntsen’s party] now possess.”

It’s unclear how long the legal discovery phase might take, especially because the Justice Department’s intervention will likely spur a series of procedural adjustments in the case. paul.sisson

@ sduniontribune.com

Medicare for More

The following article from the Atlantic states that lowering of the Medicare age from 65 to a younger age might infuse needed money into the Medicare system. Additionally, rates for those who are younger and not Medicare eligible might benefit if older sicker people enroll in Medicare. All will depend on the healthcare needs of those who are shifted around.

Hillary Clinton’s new proposal to expand coverage for middle-aged adults provides a glimpse at how she would make Obamacare her own.

VANN R. NEWKIRK II

MAY 23, 2016

What’s the next step for Obamacare? Much of the 2016 presidential race functions as a referendum on just what to do with the the six-year-old Affordable Care Act. Despite some mixed returns on costs and the stability of insurance markets, the health-reform law has brought the uninsured rate to its lowest point in American history. Reflecting that mixed legacy, most Americans now favor modifications to the ACA over continuing to implement it as it is or repealing it.

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That puts most Americans on the opposite side of whatever Donald Trump’s health care plan might be. But both Hillary Clinton and Bernie Sanders have plans to modify and expand Obamacare. Sanders’s plan of “Medicare for All,” a radical overhaul of the current system based on a single-payer system, has received most of the attention. Clinton’s more modest proposals to expand tax credits and allow undocumented immigrants access to health-insurance marketplaces have garnered less press. But recently, Clinton has made waves with a new idea to allow people over 50 or 55—the specifics have not yet been announced—to purchase Medicare plans.  At present, only those over 65 and a select few of their dependents are eligible for Medicare. This “Medicare for More” concept is a significant addition to the Clinton health plan, but what does it mean for the future of Obamacare?

A new report from Avalere extrapolates what it might mean for the future of 50-somethings. There are about 13 million people between the ages of 50 and 65 who are either uninsured or have purchased private insurance on the Obamacare marketplaces. This population represents most people in the age range without affordable employer- or group-insurance coverage and who don’t qualify for Medicaid. Assuming that this is the population that would be eligible for Clinton’s Medicare for More, Avalere reports that it is “unclear” if Medicare would automatically be a good deal for them.

With no knowledge of premiums or subsidies yet, a Medicare buy-in might just be too costly for those uninsured adults above 50 who have low incomes but are ineligible for Medicaid because of state rules. For those in private plans, Medicare has a distinct number of cost disadvantages, including a 20 percent cost-sharing requirement, no lifetime cap on out-of-pocket expenditures, and drug benefits that are generally less generous. Also, it is unclear if people under 65 could qualify for the Medicare Advantage plans that help fill in gaps in coverage. Sicker elderly adults regularly run up against the limits of Medicare, and it is hard to envision cases in which Medicare would make more financial sense for near-elderly adults with serious chronic illnesses than medium-cost marketplace plans.

Medicare for More is a step away from Clinton’s position as a defender of President Obama’s legacy and towards her central policy identity as an architect of American health policy.

But Medicare has always been a good deal for those who don’t use many health-care services, and it might beat out low-cost marketplace plans for healthy adults between 50 and 65 with few health problems. Medicare provides access to one of the broadest networks of physicians, providers, and benefits possible, and consumers value continuity. A buy-in at 50 could allow people to remain on the same insurance coverage with the same providers for the rest of their lives. Also, while Medicare has not been shown to have a serious effect on health trajectories for uninsured adults who become enrollees at age 65, at age 50 it might provide services early enough to change outcomes. Medicare also provides protection against medical debts, and if premiums could be made affordable to uninsured adults over 50, it could have serious value as health issues mount with age.

Medicare for More might have more value to the Medicare program than to any individual beneficiary. People between 50 and 65 are healthier than those over 65, and many of the costs that penalize high utilization can be seen as offsets for having to cover the most expensive population in the country. Even for Medicare, which has broad power to affect prices and policy, covering services, visits, drugs, surgery, and hospital stays costs money, and as patients near costly end-of-life holding patterns, the cost curve skyrockets. Adding healthier, younger people to the risk pool might bring down the per-person costs of the program. If the subsidies are equivalent to marketplace subsidies, premiums and savings from the over-50 crowd could actually cut back net costs for the Medicare albatross. Removing more middle-aged adults from marketplace risk pools might actually make insurance cheaper for young adults as well.

The results of a Medicare buy-in for potential beneficiaries and the program will likely depend on specifics as detailed by the Clinton campaign, but its rhetorical value is much more readily assessed. Allowing private purchase of one of America’s two big public-insurance programs is an addition to Obamacare’s willingness to blur the lines between public and private insurance, risk, and public-health responsibility. The proposal gives Clinton ammunition both against Sanders in the primary and, should she win, Trump in the general.

But above all, Medicare for More is a step away from Clinton’s position as a defender of President Obama’s legacy and towards her central policy identity as an architect of American health policy. Obamacare could very well be a platform for Clinton to achieve some of the goals that remain unfulfilled from the 1993 health plan that she spearheaded. Combined with some recent support from Clinton for the idea of a public option, a Medicare buy-in can be seen as a very Clinton-esque way of using the market to provide universal care. The free market solution to coverage, along with the major expansion of Medicare as a coverage pathway for non-elderly adults, is reminiscent of the ‘93 plan, and the population that it impacts is massive. Medicare for More would also cement Obamacare as the foundational law of all of American health policy, and establish a regime of incrementalism not unlike the coverage shifts seen in the decades between Medicare and Obamacare. The proposal might open the door for other shifts, such as allowing even younger people or government employees Medicare buy-ins.

For those further to Clinton’s left, however, Medicare for More might close the door for hopes of more radical overhauls while the figurative iron is still hot and while the ACA is still a hotly debated law. Sanders’s plan rests on frustrations about the compromising nature of the Affordable Care Act, which whittled down some of the more ambitious coverage plans in favor of  a market-based solution that still leaves millions uninsured. The current Obama-Clinton doctrine of health-care views zero uninsurance as a lofty and likely unreachable goal more than a first-order cause. Much of Sanders’s momentum with Medicare for All comes from the fact that the liberal benchmark––a universal public option supported by high, progressive taxes––has still not been reached. Clinton’s incrementalism would in all likelihood reset the clock on that dream.

Medicare for More isn’t Sanders’s Medicare for All, and it certainly isn’t what many Sanders supporters are looking for, but it is a step for Clinton and would be a significant addition to the massive impact of Obamacare. If Clinton does wind up in the White House, it could be the beginning of a piecemeal process to bring the ACA closer and closer to its originally intended ideal of universal coverage, as Obamacare is a perfect platform for incremental increases in coverage. Now, it is another sign that the work of providing coverage and making the health care system more affordable and better is not yet done.

Medicare Fraud is a Big Concern

Below is an article from the Los Angeles Times, dated Saturday May 7, 2016 which addresses the conviction of two doctors.

2 doctors found guilty of fraud

The pair tried to steal almost $9 million in hospice scheme, prosecutors say.

BY JASON SONG

Two Southern California doctors were found guilty this week of falsely certifying that their patients were terminally ill as part of a larger scheme to bilk Medicare and Medi-Cal out of $8.8 million in hospice-related services, according to federal prosecutors.

Sri “Dr. J” Wijegoonaratna, 61, of Anaheim was convicted of seven counts of healthcare fraud and Boyao Huang, 43, of Pasadena four counts after a two-week trial.

Prosecutors said the scheme involved Covinabased California Hospice Care, where employees paid so-called marketers to recruit Medicare and Medi-Cal beneficiaries. The patients were assessed by nurses to determine whether they were terminally ill, according to federal prosecutors.

Prosecutors argued that regardless of the assessments, Wijegoonaratna and Huang certified that the patients were dying, even though most were not. The certifications were then used to submit bills for unnecessary hospice-related services, prosecutors said.

“In fact, only a small percentage of patients died — notwithstanding the two doctors declaring they needed hospice care,” said Eileen M. Decker, the U.S. attorney for the Central District of California.

Prosecutors said also that Wijegoonaratna recruited some patients into the scheme and received tens of thousands of dollars in kickbacks. The California Medical Board has revoked his medical license.

The scheme was shut down in June 2013, according to prosecutors.

Wijegoonaratna and Huang will be sentenced Aug. 15 and face a maximum sentence of 10 years in prison for each count. Four other defendants have already pleaded guilty.

Jason.Song@latimes.com   Twitter: @byjsong

Aid-In-Dying Law In Effect June 9

An article from the Los Angeles Times, dated March 11, 2016
Terminally ill patients should be consulting with physicians now if they want to end their lives, advocates say.
BY PATRICK MCGREEVY
SACRAMENTO — California’s terminally ill patients should begin talking to physicians now if they want to end their lives, advocates said Thursday after a legislative vote triggered a June 9 start date for the End of Life Option Act.
The law, which allows doctors in California to prescribe lethal doses of drugs to terminally ill people who want to hasten their deaths, includes a time-consuming approval process that could take several weeks, said Toni Broaddus, California campaign director for the group Compassion & Choices.
Gov. Jerry Brown signed the measure last year, but it wasn’t until the Legislature adjourned a special session in Sacramento on Thursday that June 9 was set for when it becomes legal for physicians to write lethal prescriptions without fear of criminal prosecution.
Broaddus said doctors can begin explaining options and considering requests. “We are telling people to start talking to their doctor now,” said Broaddus, whose group, formerly known as the Hemlock Society, helped pushed the bill to approval and has launched a bilingual education campaign on how to participate.
Sen. Bill Monning (D-Carmel), a co-author of the law, predicted discussions will begin before June 9 as patients make sure their doctors are up to speed on the law and physicians explain all options, including those not involving the legislation, such as hospice care.
“I certainly expect it’s going to provoke conversations within families and between terminally ill patients and physicians,” Monning said.
Senate leader Kevin de León (D-Los Angeles) said on the Senate floor just before the adjournment vote Thursday that the law “ensures Californians have access to humane and compassionate options to limit suffering at the end of life.”
The bill had failed to win needed support during the regular session, so supporters introduced it in special session, allowing it to bypass committees where opposition was strong.
The approval of the law through “controversial legislative tactics” was denounced again Thursday by Tim Rosales of Californians Against Assisted Suicide.
The group “remains strongly critical of this new law, and its lack of medical oversight and actual patient safeguards,” he said. “We will continue working with our partners, including doctors, patients and disability rights organizations, to educate those impacted and vulnerable, as well as working to limit the law’s harms and prevent any expansion.”
California will be one of six states to allow physicians to prescribe lethal drugs to the terminally ill.
The California Medical Assn. published guidelines on the law in January that spell out the requirements for terminally ill patients diagnosed with less than six months to live. The patients must make two oral requests at least 15 days apart and one written request that is signed, dated and witnessed by two adults. Patients must also fill out forms that were included in the legislation.
The process can be further delayed if the physician suspects mental illness requiring an evaluation by a mental health professional.
Even if some terminally ill patients begin the process now, Broaddus said she does not expect a large number of deaths June 9. In Oregon, which previously adopted the same law, patients on average wait 45 days to take the prescribed lethal dose.
The delays are often the result of patients wanting the medication in hand just in case but waiting until the last possible moment to take it, Broaddus said.
The California Medical Assn., which was neutral on the law, does not recommend whether patients and doctors should begin discussions now, according to spokeswoman Molly Weedn. “It’s up to those doctors and their patients and the individual situations” to determine what is best for their course of care, she said. patrick.mcgreevy
@ latimes.com
Twitter: @mcgreevy99

Kaiser Medical School to be in Pasadena

Kaiser’s medical school will add focus to more practical areas of medical care.

here is an article from the Los Angeles Times date, March 11, 2016
Site is near freeways, public transportation, affordable housing, medical provider says.
BY SAMANTHA MASUNAGA
Kaiser Permanente is moving forward with its ambitious plan to open a medical school that’s more in tune with new technologies and local communities.
The Oakland-based healthcare provider said Thursday its institution will be located in Pasadena. And it talked about how it will try to attract a more diverse student body.
Kaiser said it chose central Pasadena because the site is close to major freeways, public transportation options and affordable housing. Kaiser is also well-established in the surrounding area, with 14 hospitals in Southern California and medical office complexes in Pasadena and Glendale. The school will also be within several miles of facilities where students will be trained.
“We have major medical facilities and resources in that particular marketplace, so we feel really great about the extension of Kaiser Permanente beyond the four walls of that medical school,” said Kaiser Chairman and Chief Executive Bernard Tyson.
Pasadena’s diverse community was another driving factor, as Tyson said it was “essential” to the model of medical education Kaiser wants to establish. Kaiser officials have said it wants to recruit more minority students and teach doctors how to care for an increasingly diverse patient population.
There are no set plans yet for recruitment, but Kaiser is considering offering scholarships or tuition forgiveness to students who can help them “reach the communities that we wish to reach,” said Dr. Edward Ellison, executive medical director of the Southern California Permanente Medical Group.
“When you look at what’s happening in the country today, healthcare has never gone through as much change as it has today,” he said. “We believe that the way in which we deliver care has a lot of applicability for solving challenges of the future.”
Kaiser first announced plans in December to open a medical school.
The campus size in Pasadena, as well as the tuition, has yet to be determined.
The school will be built on land that Kaiser already owns. The property, located at 94 S. Los Robles Ave., currently houses an unoccupied building, which will be torn down and replaced with a larger building, Kaiser spokesman Marc Brown said. A Kaiser office building and the Kaiser Permanente Department of Research and Evaluation are on the same lot and will remain there, he said.
That part of Pasadena is already being revitalized, said Mayor Terry Tornek. A new residential building and hotel are set for construction nearby and other parts of the city are also seeing new developments.
“It’s a big deal,” he said of the medical school. “You bring in these students, you bring in their instructors, you bring in their support staff…. It has a multiplier effect.”
Kevin Trieu, owner of Beany’s Cafe, located a block away from the Kaiser school site, said he thought the institution could increase the foot traffic around his restaurant.
“Any time you get more people within walking distance to us, then that’s going to generate business for us, especially since we don’t have our own parking lot,” he said. “The fact they’re so close, I think it’s going to be wonderful.”
Groundbreaking for Kaiser’s medical school is planned for next year, and the first class of about 40 to 50 students is expected in 2019. In time, Tyson said he hoped the class size would increase to 200 to 300.
He said the plan for the medical school was an evolution of what Kaiser was already doing. The organization has more than 600 physicians in residency programs at its facilities and thousands of others do some training at Kaiser.
Kaiser has said that its approach to medical education will differ from that of many established medical schools. The curriculum and teaching methods will more closely align to the company’s commitment to quickly adopting new technology and adhering to the latest medical evidence in patient care. Kaiser has been a leader nationally at adopting electronic medical records and offering doctor visits online.
It also plans to integrate hands-on learning early on so that “what you’re learning, you’re going to immediately apply,” Ellison said.
For example, Kaiser plans to train students as emergency medical technicians when they arrive at the school to give them a practical grounding in healthcare. Students will also go into the community, visiting patients’ homes and learning how to better implement health behavioral changes, Ellison said.
“Not all innovation is about shiny new technology,” he said.
Analysts have said that a medical school teaching Kaiser’s method of healthcare might not appeal to all students. Critics have also worried that a Kaiser medical school would focus on cutting costs that could negatively affect patient care, since some patients have said Kaiser’s system limited their care.
Kaiser operates 38 hospitals nationwide, owns hundreds of clinics and has almost 18,000 salaried doctors at its affiliated medical groups. Nearly 80% of its 10.2 million members are in California, though the healthcare provider operates in eight states and the District of Columbia.
With the location settled, Ellison said Kaiser is now working to create a curriculum, forming a search committee for the school’s first dean and going through the accreditation process. samantha.masunaga
@ latimes.com
Twitter: @smasunaga

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